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Battling Asthma in the Workplace

Asthma image

If you wheeze or have trouble breathing only when you are at work, you may have occupational asthma. Since World War II, as industries have increased use of simple chemicals and organic compounds, breathing hazards have increased. Some 200 substances – gases, vapors, and organic and inorganic dusts – found in manufacturing workplaces and among certain occupations have been identified as causes of asthma. It’s estimated that some 11 million workers are exposed to one of these substances.

Who gets occupational asthma?
People who get occupational asthma are those who either become sensitized to an allergen in the workplace and on subsequent exposure have an allergic reaction to the allergen or are already asthmatic and have very sensitive airways that react to irritants in the workplace.

What are symptoms of occupational asthma?
Physical symptoms include coughing, wheezing, breathing problems, and chest tightness. The skin, eyes, and nose may become inflamed.

How is occupational asthma diagnosed?
To diagnose the condition, your doctor will begin with a careful medical history. This includes a study of the work environment to identify exposure to allergens, gases, vapors, dusts, and irritants. Clues include onset of symptoms within months of starting a job; use of a new industrial agent or process; improvement in symptoms after leaving the work area, on weekends, or during holidays; symptoms that worsen during certain production procedures when exposure is greatest; and other workers who are similarly affected.

If there is a period of time between first exposure to a workplace agent and onset of symptoms, allergies should be suspected. To confirm your asthma, your doctor will give you breathing tests before and after giving you an airways-opening medication.

In a challenge test, the doctor may try to reproduce symptoms. You will be asked to inhale histamine or methacholine to provoke a response. The value of such challenges may be limited, though, if there has been a long delay in seeking medical care. To try to confirm the relationship between asthma and a worksite agent, your doctor may use a worksite substance suspected to cause your asthma in the challenge test.

If there is a period of time between first exposure to a workplace agent and onset of symptoms, allergies should be suspected.

If the doctor suspects that the asthma is caused by an allergy, skin testing may be used. An extract of the suspected allergen is used to prick or scratch your skin. If you are allergic to the substance, the area will turn red and swollen. Sometimes skin testing is too dangerous because the suspected agent is too toxic. Then blood tests, such as radioallergosorbent test (RAST), may be used. They are more costly and less sensitive than skin tests, though.

If you still work, you can measure changes in peak flow with a peak flow meter every one to two hours during the work shift and while away from the workplace. Such monitoring may continue for about three weeks – two weeks at work and one week off work. Also record when symptoms and exposures occur and when medication is needed. This allows comparison of symptoms at work versus those away from work.

How can it be treated?
If allergy-induced asthma has been diagnosed, you should avoid exposure to the agent that triggers an attack. This may involve moving to another area of the workplace or leaving the workplace altogether. Staying in contact with the substance can be life threatening.

If you have irritant-induced asthma, you should work with on-site healthcare providers and supervisors to manage the asthma. You should discuss avoidance of the allergen, the ventilation and respiratory protection available, and working in a smoke-free environment.

Medical treatment (including anti-inflammatory therapy with inhaled steroids, sodium cromolyn, or nedocromil) may prevent worsening of symptoms at work by reducing the underlying irritability of the airways. When it is impossible to leave the workplace, symptoms can be lessened with inhaled sodium cromolyn and corticosteroids. Drug therapy does need routine monitoring.

Peak flow monitoring will help you understand how severe your asthma is and what treatment you need. It requires maximal effort and motivation, though. Make sure you are carefully trained in use of the peak flow meter and committed to using this method to control your disease.

Asthma cannot be cured, but it can be controlled by avoiding the triggers of an asthma attack. People with allergy-induced asthma should change their worksite altogether. People with irritant reactions may choose to continue working. For them, simple filter-type facemasks will not adequately protect them from exposure to allergens. Air hoods that prevent them from inhaling the air from the factory floor work better. A helmet with a respirator that protects against dusts also works better.

 

Source: Asthma and Allergy Foundation of America, www.aafa.org

This article was originally published in Coping® with Allergies & Asthma magazine, Winter 2010-2011.